Aortic regurgitation
Aortic regurgitation is diastolic backflow of blood from the aorta into the left ventricle from valve or aortic root disease. Chronic disease causes volume overload with a wide pulse pressure and a decrescendo diastolic murmur, while acute severe regurgitation is a surgical emergency; severe symptomatic or decompensating disease is treated with valve replacement.
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What this article covers
- Overview
Definition: aortic regurgitation is diastolic reflux of blood from the aorta back into the left ventricle, from disease of the valve leaflets or the aortic root.
- Epidemiology
Chronic aortic regurgitation arises from bicuspid valves, aortic root dilation, and rheumatic disease.
- Risk factors
Congenital bicuspid aortic valve. Aortic root dilation: hypertension, connective tissue disease (Marfan), and bicuspid aortopathy.
- Pathophysiology
Chronic volume overload: regurgitant flow adds volume to the left ventricle, causing eccentric hypertrophy and dilation, initially with preserved output.
- Clinical features
Chronic: exertional dyspnea, palpitations, and awareness of a forceful heartbeat.
- Differential diagnosis
Pulmonic regurgitation: an early diastolic murmur at the left sternal border, distinguished from aortic regurgitation by louder intensity with inspiration and the absence of a wide pulse pressure or bounding pulses (Pulmonic regurgitation).
- Diagnosis
Establish and grade with echocardiography assessing the regurgitant jet, vena contracta, and ventricular size and function: the diagnostic basis is echocardiography defining the mechanism (leaflet…
- Management
First-line, replace the valve in severe symptomatic or decompensating disease: aortic valve replacement (or repair) is indicated for severe regurgitation with symptoms, a reduced ejection fraction…
- Complications
Progressive left ventricular dysfunction and heart failure.
- Prognosis
Excellent while asymptomatic with preserved function.
- Prevention
Control hypertension (below 130/80 mmHg) to limit root and ventricular stress.
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Related articles
- Aortic stenosis
Aortic stenosis is obstruction to left ventricular outflow from a narrowed aortic valve, most often calcific degeneration in older adults or a bicentric bicuspid valve earlier in life. Symptoms of angina, syncope, or heart failure mark a poor prognosis, and severe symptomatic disease is treated with valve replacement (surgical or transcatheter).
- Aortic dissection
Aortic dissection is a tear in the aortic intima allowing blood to split the media, creating a false lumen, and is a surgical emergency. Type A (ascending) dissection needs emergency surgery, while type B (descending) is usually managed medically with rapid heart-rate and blood-pressure control; the priority is impulse control with a beta-blocker first.
- Heart failure
Heart failure is a clinical syndrome of impaired cardiac filling or ejection causing congestion and reduced perfusion, classified by ejection fraction. Diagnosis integrates symptoms, signs, natriuretic peptides, and echocardiography, and treatment of reduced-ejection-fraction disease is quadruple guideline-directed therapy, with device therapy and cause-specific management.
- Pulmonic regurgitation
Pulmonic regurgitation is diastolic backflow from the pulmonary artery into the right ventricle, most often from pulmonary hypertension or after repair of congenital disease such as tetralogy of Fallot. Chronic severe regurgitation causes right ventricular volume overload, and timing of pulmonary valve replacement is guided by right ventricular size and function.
- Mitral stenosis
Mitral stenosis is obstruction of left atrial emptying from a narrowed mitral valve, overwhelmingly rheumatic in origin. It causes left atrial hypertension, atrial fibrillation, and pulmonary congestion, with a diastolic rumble and opening snap; severe symptomatic disease is treated with percutaneous balloon valvuloplasty or valve surgery.
- Patent ductus arteriosus
Patent ductus arteriosus is persistence of the fetal ductus connecting the aorta and pulmonary artery, causing a continuous machinery murmur and a left-to-right shunt. In preterm infants it is treated with prostaglandin inhibitors; in others it is closed by transcatheter device or surgery, before pulmonary vascular disease develops.
- Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.